HEDIS Outreach Coordinator

Job Description
The HEDIS Outreach Coordinator within the Healthy Outcomes Team conducts outreaches to our Medicare members to inspire and encourage healthy behaviors through innovative, compassionate and empathetic telephonic communications. The goal of each outreach is to ensure that every member has a clear understanding of the available benefits that are afforded to them under their Medicare plan.
 
The Healthy Outcomes Coordinator facilitates Provider and Member outreaches telephonically to ensure Medicare member receipt of important clinical tests and services to improve Star health outcomes.
Provides support for Healthcare Effectiveness Data and Information Set (HEDIS) quality initiatives by performing the following:
- Outreach to members who don’t have a record of the designated services, effective capture of barriers and data collection, use of motivational interviewing skills to provide solutions in order to close the gap in care, and providing best in class support to each member.
- Ensures that every customer is treated professionally, with respect and all questions are thoroughly answered and/or triaged and responded to.
- Acts as an advocate for our Medicare members preventive health needs.
- Collect effective data elements in the CRM tool to support medical record chasing for HEDIS medical record documentation and services.

Fundamental Components

• Initiates outbound calls to members and providers to collect information and provide care coordination assistance in obtaining services (e.g. schedule appointments, provider appointment reminders, coordinate transportation, etc.) to avoid delays in treatment and improve member health outcomes and Medicare HEDIS Star measures.
• Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
• Documents member participation in outreach activities in accordance with abstraction and audit standards. Distributes educational information to members and providers and closes the loop on the member case.
• Maintains database to track member compliance. Identifies when to refer member to additional Aetna resources for further intervention.
• Identifies potential resources and initiates collaboration with providers to improve member health outcomes and HEDIS measures.
• Conducts HEDIS provider chart request calls and mailings.
• Records and documents all member and provider outreach activity.
• Assists in the development and standardization of outreach talking points, scripting and data collection tool to improve HEDIS data collection and service documentation.
• Documents member history and participation in outreach activities in the CRM tool.
• Conducts HEDIS provider appointment and documentation chart request calls and chasing.
• Maintains CRM tool to track member history and compliance.
• Identifies opportunities to partner with other Aetna departments and resources, community organizations and internal stakeholders on process improvements, special projects, health events, and presentations (i.e., health fairs, community events and member meetings).
• Performs other duties as required.

Background Experience

• Minimum 3 years recent and related experience within healthcare, healthcare marketing, outreach and/or health education, health coaching and disease management experience required.
• 3 – 5 years of experience in a healthcare setting with direct communication with various levels of management including medical providers required.
• Effective communication skills and experience speaking with medical providers and/or clinical staff.
• Recent and related experience working with HEDIS screening measures and/disease management, behavior change.
• Ability to apply creative thinking skills when needed to solve members’ concerns and have a desire to advocate for them.
• Ability to thrive on change, to adapt to multiple focuses in short amounts of time.
• Demonstrated ability to de-escalate situations.
• Ability to work independently, apply critical thinking skills when needed, multitask with ease, and demonstrate professionalism in all interactions.
• Demonstrated empathy, compassion and listening skills.
• Windows based application knowledge with ability to use standard corporate software packages and corporate applications with a high degree of computer literacy.
• Bilingual or multilingual candidates heavily preferred.
• Education and Certification Requirements
• Bachelor’s degree or equivalent heavily preferred.
• Medical certification (certified nursing assistant, medical assistant, etc.) is strongly recommended but not required.

Additional Job Information
This is an exciting chance to work with our Medicare Members to improve their health outcomes and a unique career opportunity.

Education
High School diploma, G.E.D. or equivalent experience

Percent of Travel Required
0 - 10%